• Anne-Julie Gagné, Philippe Voyer, Valérie Boucher, Alexandra Nadeau, Pierre-Hugues Carmichael, Mathieu Pelletier, Emilie Gouin, Simon Berthelot, Raoul Daoust, Machelle Wilchesky, Hélène Richard, Isabelle Pelletier, Stephanie Ballard, Antoine Laguë, and Marcel Émond.
• *Axe Santé des populations et pratiques optimales en santé,CHU de Québec,Hôpital de l'Enfant-Jésus,Québec,QC.
• Can J Emerg Med. 2018 Nov 1; 20 (6): 903-910.

ObjectivesDelirium is very frequent in older patients presenting to the emergency department (ED), but is often undetected. The purpose of this study was to evaluate the performance of the French version of the 4 A’s Test (4AT-F) for the detection of delirium and cognitive impairment in older patients.MethodsThe study was conducted in four Canadian ED. Participants (n= 320) were independent or semi-independent patients (able to perform ≥5 activities of daily living) aged 65 and older and had an 8-hour exposure to the ED environment. The Telephone Interview for Cognitive Status (TICS-m), the Confusion Assessment Method (CAM) as well as the 4AT-F were administered to patients at the initial interview. The CAM and 4AT-F were then administered twice a day during the patients’ ED or hospital stay. The 4AT-F’s sensitivity and specificity were compared to those of the CAM (for delirium), and to that of the TICS (for cognitive impairment).ResultsOur results suggest that the 4AT-F has a sensitivity of 84% (95% CI: [76, 93]) and a specificity of 74% (95% CI: [70, 78]) for delirium, as well as a sensitivity of 49% (95% CI: [34, 64]) and a specificity of 87% (95% CI: [82, 92]) for cognitive impairment.ConclusionThe 4AT-F is a fast and reliable screening tool for delirium and cognitive impairment in ED. Due to its quick administration time, it allows a systematic screening of patients at risk of delirium, without significantly increasing the workload of the ED staff.

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